Organization
HERGENRADER DENTAL REHAB PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN HERGENRADER (OWNER)
(315) 454-6000
Entity
Organization
Contact information
Practice address
3102 EAST ELK LANE, FREMONT, NE 68025
(315) 454-6000
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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